STANDARD Stepped Therapy Agents ~ 2011 The following drugs will require prior authorization if the condition is not met when the pharmacist would attempt to transmit a prescription claim. Your doctor will coordinate this approval for you. If the prescription is approved, Coventry Health Care will cover the cost. You will be responsible for the copayment. If the request is not approved, it does not mean your doctor cannot prescribe the medicine for you. It means that you are responsible for paying the prescription in full. Self- administered injectable agents also require prior authorization and can be found on a separate list. Drug Condition
Trial & failure of Risperdal* or Seroquel
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of metformin/ER (at least 1500mg/d)
ActoPLUS Met XR (pioglitazone / metformin ext rel)
Trial & failure of metformin/ER (at least 1500mg/d)
Ambien CR (zolpidem extended release)
Trial & failure of Ambien* or Sonata*, AND Lunesta
Trial & failure of Lactulose* or Miralax*
Trial of Aricept 10mg QD for at least 3 months
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of 2: Claritin OTC*, Zyrtec OTC*, Allegra OTC
Coreg CR (carvedilol extended rel)
Trial & failure of Mevacor*, Pravachol* or Zocor*
Detrol / Detrol LA (tolterodine / extended release)
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Trial & failure of metformin/ER (at least 1500mg/d)
Effexor XR* capsules (venlafaxine extended rel)
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Trial & failure of Risperdal* or Seroquel
Trial & failure of metformin/ER (at least 1500mg/d)
Gelnique (oxybutynin topical gel)
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Trial & failure of Risperdal* or Seroquel
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of Neurontin* and Lidoderm
Trial & failure of Tenex* or Catapres*, AND a stimulant
Trial & failure of Risperdal* or Seroquel
Janumet (sitagliptin / metformin)
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of Tenex* or Catapres*, AND a stimulant
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of Risperdal* or Seroquel
Trial & failure of Mevacor*, Pravachol* or Zocor*, AND Crestor
Trial & failure of Apriso, Asacol or Asacol HD
Trial & failure of Mevacor*, Pravachol* or Zocor*, AND Crestor
This is the most current list at the time of printing and is subject to change. Last update November 1, 2011
Trial & failure of Ambien* or Sonata*
Luvox CR (fluvoxamine extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Paxil CR* (paroxetine extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Ambien* or Sonata*, AND Lunesta
Trial & failure of Risperdal* or Seroquel
Trial & failure of oral Toradol* AND one additional NSAID
Symbyax (olanzapine / fluoxetine)
Trial & failure of Risperdal* or Seroquel
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Trial & failure of metformin/ER (at least 1500mg/d), AND Actos or
Duetact, AND Januvia/Janumet or Onglyza/Kombiglyze
Ultram ER (tramadol extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Vytorin (simvastatin/ezetimibe) 10/10 only
Trial & failure of Mevacor*, Pravachol* or Zocor*
Trial & failure of 2: Claritin OTC*, Zyrtec OTC*, Allegra OTC
Trial & failure of Risperdal* or Seroquel
*indicates generic available Italics indicate non-formulary agents # indicates Step Therapy required for age 18yr and under; Prior Auth required for age 19yr and over
This is the most current list at the time of printing and is subject to change. Last update November 1, 2011
AUDIT GUIDANCE STATEMENT Existence and Valuation of Inventories in the Context of the Historical Cost System This Statement of Auditing Practice was approved by the Council of the Institute of Singapore Chartered Accountants (formerly known as Institute of Certified Public Accountants of Singapore) in May 1985. SAP 4 superseded the SAP of the same title in June 2004. No sub
Curriculum Vitae August 16, 2012 Medical Licenses: Texas: J0175 DUNS #: 96-060-3116 Board Certifications: Diplomate American Board of Anesthesiology #32715 Diplomate American Board of Pain Management Certification: Certified for outpatient management of opioid dependency. Fellowship Training: Pain Management University of Texas Health Science Center University of Texas Health Science Ce
STANDARD Stepped Therapy Agents ~ 2011 
Trial & failure of Ambien* or Sonata*
Luvox CR (fluvoxamine extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Paxil CR* (paroxetine extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Ambien* or Sonata*, AND Lunesta
Trial & failure of Risperdal* or Seroquel
Trial & failure of oral Toradol* AND one additional NSAID
Symbyax (olanzapine / fluoxetine)
Trial & failure of Risperdal* or Seroquel
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Trial & failure of metformin/ER (at least 1500mg/d), AND Actos or
Duetact, AND Januvia/Janumet or Onglyza/Kombiglyze
Ultram ER (tramadol extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Vytorin (simvastatin/ezetimibe) 10/10 only
Trial & failure of Mevacor*, Pravachol* or Zocor*
Trial & failure of 2: Claritin OTC*, Zyrtec OTC*, Allegra OTC
Trial & failure of Risperdal* or Seroquel
* indicates generic available
Italics indicate non-formulary agents # indicates Step Therapy required for age 18yr and under; Prior Auth required for age 19yr and over
This is the most current list at the time of printing and is subject to change. Last update November 1, 2011